Apply for an Account - Fall Fittings, Inc.

Company Name(Required)

Federal ID(Required)

Requested Line of Credit(Required)

Types of Business:(Required)

Number

Owners, Officers, Partners

Name(Required)

Title(Required)

Email(Required)

Phone(Required)

Name

Title

Phone

Name(Required)

Title

Phone

Bank:(Required)

Name:(Required)

Title:(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit Trade Reference

Company(Required)

Contact(Required)

Email(Required)

Phone(Required)

Company

Contact

Phone

Company

Contact

Phone

Company

Contact

Phone

Authorized Buyer Information

List all authorized to purchase on this account.

Name(Required)

Title(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

Title

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

Title

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

Title

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Shipping Information

Please attach as many additional copies of this page for additional shipping locations as needed

Physical Delivery Address

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Receiving Contact

Name(Required)

Title(Required)

Primary Receiving Specifications

*Please be sure to note if do not accept deliveries during any lunch / break periods

Monday From

Monday To

Tuesday From

Tuesday To

Wednesday From

Wednesday To

Thursday From

Thursday To

Friday From

Friday To

Location of unloading(Required)

Is Forklift unloading available

Max Weight for Forklift

Is Crane unloading available(Required)

Max Weight for Crane(Required)

Do you require material to be tarped in inclemenet weather(Required)

Billing Information

*Please be sure to note if do not accept deliveries during any lunch / break periods

Email Address to Email Invoices(Required)

Email Address to Email Statements(Required)

Email Address to Email Payment Receipts(Required)

Billing Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you require PO numbers on your invoices?(Required)

Do you require a job reference on your invoices?(Required)

Taxable?(Required)

Billing / Accounts Payable Contact

Name(Required)

Title(Required)

Email(Required)

Phone(Required)

Mill Certifications

Do you require Mill Test Reports with your orders?(Required)

If Yes, how do you want mil certifications sent:(Required)

If mill certifications and noted to be sent with invoice that will be sent to the same email address, we have on file for invoices.

If mill certifications are be sent by email, who should they be sent to

Name(Required)

Title(Required)

Email(Required)

Phone(Required)

All information contained in the application is true to the best of my knowledge and belief and I understand that you will rely on it if you grant credit. I understand that terms of sale are Net 30 days unless otherwise agreed in writing. I agree to pay finance charge of 1 ‘2% (18% per annum) on past due accounts. I also agree that if my account is referred to an attorney for collection, I will pay the reasonable fee for such attorney or collector. I authorize and request that my depository institution release credit information to you and I intend that a photocopy of this authorization be as valid as the original.

Name – Please Print(Required)

Signature(Required)

Signature Date(Required)

Title(Required)